Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XL0004X | Low Vision | OT20099 | FL |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 312122 | LA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT20099 | FL |
N | 225XP0200X | Occupational Therapist - Pediatrics | 312122 | LA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT20099 | FL |
NPI | 1902461387 |
---|---|
Provider Name | Savannah W Coffey |
First Address | Knoxville, TN 37914-9746 |
Second Address | Leesville, LA 71446-4014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2019 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134675471 | DRIVER'S LICENSE (01) | TN |